The drug policy debate in Europe

On October 18, 1996, the International Herald Tribune
published an editorial by Joseph A. Califano, Jr. condemning Dutch cannabis
policy. Califano is an American lawyer and former Washington lobbyist
who moved within the inner circles of the Democratic Party leadership.
He served as Secretary of Health, Education, and Welfare from 1977 to
1979.[2] He now heads
the Center on Addiction and Substance Abuse (CASA), an antidrug organization
in New York City. From his initial press conference announcing the opening
of CASA in 1990 until the present, Califano has been highly critical of
drug use, claiming that it is the principal and direct cause of crime,
health problems, declining worker productivity, homelessness, and a range
of other problems. With respect to drug policy, however, Califano and
CASA have been uncritical supporters of the U.S.-style punitive prohibition.

Califano's editorial attacks Emma Bonino, Commissioner for Consumer Policy
and for Humanitarian Affairs of the European Union, for advocating Dutch-style
decriminalization of cannabis in EU countries.[3]
After the European Drugs Observatory issued a report showing "little
relationship" between strict prohibitionist policies and reductions
in the number of drug offenses, Bonino criticized harsh drug prohibition
and suggested that EU countries consider the Dutch approach to drug policy.
She noted, for example, that The Netherlands had less crime and AIDS than
elsewhere in Europe.

Califano labels Bonino a dangerous and deceptive legalizer. Instead of
responding to her evidence and arguments about Dutch drug policy, Califano
crudely paraphrases Bonino's position, asserting that it consisted of
pernicious "myths." To counter these, he offers what he called
"facts" purporting to show that "legalization would be
a disaster for European children and teenagers." However, Califano's
article itself consists of myths which distort both the substance of Bonino's
critique of drug prohibition and the nature of Dutch drug policy.

Califano's distortions warrant careful analysis as a case study in how
misinformation fuels the war on drugs. He does not offer an even-handed
analysis of the potential risks and benefits of various drug policy options
now in place or under consideration in EU countries. Rather, his editorial
propagandizes for U.S.-style punitive prohibition. Califano invokes selective
"facts," cites unattributed figures, and misrepresents Dutch
drug policy. While such drug war ideology can take the form of short soundbites
that swim with the current of prevailing biases, reasoned discourse about
the complexities of different drug policies and their consequences requires
more time and attention to detail. What follows is a point by point examination
of what Califano neglected, misrepresented, or got wrong, presented in
the larger interest of an informed debate about drug policy options in
Europe.

Decriminalization: Success or Failure?

Califano sets out to prove that, despite popular belief to the contrary,
the policy of decriminalizing cannabis has wreaked havoc on Dutch society.
In his account, decriminalization has led to increased drug use (especially
among children), increased crime, and the rapid spread of HIV/AIDS. He
correctly notes that "the Dutch have not technically legalized drugs"
but rather have only permitted "coffeeshops to sell cannabis products
for personal consumption." He goes on to assert flatly that "this
policy has harmed youngsters," but he provides no evidence of this
alleged harm. Instead he says simply that "From 1984 to 1992, marijuana
use by Dutch adolescents jumped nearly 200%." The notion that use
of marijuana constitutes "harm" is both logically and empirically
flawed. Just as alcohol is "used" by most drinkers while "abused"
by a minority, there is no scientific evidence in either the U.S. or The
Netherlands showing that the vast majority of cannabis users abuse it
or are significantly harmed, physically or psychologically, by their use.

Even if use was tantamount to harm, there are reasons to doubt the prevalence
figures Califano cites without attribution. Since 1969 there have been
over a dozen surveys on drug use in the Netherlands, two of which offer
support for his claim. One 1984 survey found that 4.4% of Dutch youth
had tried cannabis, while a different 1992 survey by the Dutch National
Institute on Alcohol and Drugs (NIAD) found that 10.6% had done so.[4]
However, prevalence figures in the other surveys varied widely. As NIAD
itself admits, most of the surveys used different samples and methods,
which may make their findings non-comparable from year to year. The only
survey on drug use which employs rigorously comparable sampling and methods
each time it is administered is funded by the Dutch Ministry of Health
and conducted on the general population of Amsterdam (the city with the
highest concentration of coffeeshops). These surveys found that the proportion
of youth aged 12-15 who had ever tried cannabis was 4.7% in 1987, 2.9%
in 1990, and 5.8% in 1994. Among youth aged 16-19, the figures were 25.5%
in 1987, 21.7% in 1990, and 28.7% in 1994.[5]
Rather than a "200%" jump in cannabis use, these surveys show
first a modest decline in lifetime prevalence and four years hence a modest
increase.

Califano neglects to note that, like most drug users in all age groups
and countries, about two-thirds of Dutch youth with lifetime prevalence
have discontinued their use, reporting no use of cannabis in the 30 days
prior to the survey. Further, he did not compare Dutch cannabis use rates
with those in countries with different cannabis policies so that the meaning
of such figures might be clear. For example, the U.S. National Household
Survey on Drug Abuse, sponsored by the National Institute on Drug Abuse,
found that marijuana use among American youth rose sharply from 14% in
1972 to 30.9% in 1979.[6]
Califano does not point out that lifetime prevalence of marijuana use
is higher in the U.S., where hundreds of thousands of people are
arrested for marijuana offenses each year, than in Amsterdam, where small
amounts of cannabis can be sold to anyone over 18 in hundreds of coffeeshops.
Thus, Califano's claim that "legalization" causes increases
in drug use does not withstand empirical scrutiny. On the contrary, existing
evidence suggests that either there is no relationship between drug policy
and drug consumption or that the Dutch policy actually holds down cannabis
use by removing the allure of the forbidden fruit that has helped attract
so many young users in the U.S.

Califano frames his article in terms of the "myth" that "The
Netherlands has a successful legalization policy." In doing so, he
misrepresents Dutch drug policy. The 1976 drug law that created current
Dutch policy was never intended to legalize drugs per se. Rather it sought
to adopt a "pragmatic" policy to minimize the harms of drug
use. One of the law's core objectives was to "separate" the
market for cannabis (marijuana and hashish) from the market for cocaine
and heroin so that young people experimenting with cannabis would not
be drawn into the black market world where hard drugs were available.[7]
What may be so troubling for Califano and others who favor punitive prohibition
is that the Dutch "separation" policy appears to have succeeded.
For example, the rates of heroin addiction and overdose deaths in The
Netherlands have remained among the lowest in Europe throughout the more
than two decades since cannabis use was effectively decriminalizied and
the average age of addicts has crept upward.[8]

Califano claims that the Dutch public and politicians share his assessment
of decriminalization as a dangerous failure: "Dutch officials and
citizens have expressed alarm about rising use of marijuana among minors
and increasing crime and drug tourism. As a result, Parliament has moved
to cut in half the number of marijuana coffeehouses, raise the minimum
age requirement for purchasing cannabis from 16 to 18, and reduce the
amount of marijuana that an individual can buy from 30 grams to 5 grams."
This assertion blends bits of truth with several incomplete and misleading
statements. Some Dutch officials and citizens have criticized Dutch
drug policy, just as more and more Americans have criticized U.S. drug
policy. All democratic societies worthy of the name will have debate and
disagreement about all public policies. Califano chose not to mention,
however, that opponents of Dutch drug policy are a minority  primarily
from the small, religious parties of the Right. The parties of the centrist
coalition that now comprise a clear majority in Parliament support the
Dutch approach to drug problems, despite intense international pressure
against it (much of it orchestrated by U.S. officials and antidrug activists
like Califano).[9] Most
members of the Dutch Parliament, like most Dutch voters, understand that
whatever problems are associated with "drug tourism," to take
one of Califano's examples, are largely the consequence of punitive prohibition
policies in other nations. Califano also neglected to note that there
are many other respectable Dutch critics  outside and inside Parliament
 who argue for an expansion of decriminalization. This viewpoint
was given equal billing and a respectful reception at a formal panel on
drug policy at the Royal Dutch Academy of Science in the week Califano's
article appeared.

The recent changes in Dutch drug policy do not signal new or rising opposition
to cannabis decriminalization in The Netherlands. Those changes were supported
by most Dutch policy makers, including many who support decriminalization.
In keeping with the "pragmatic" philosophy which gave rise to
the policy, Dutch policy makers have always experimented and made adjustments
they thought necessary for optimum public health. Dutch authorities have
quickly closed coffeeshops that tolerate the presence of drugs other than
cannabis, that become a nuisance to the neighborhood, or that otherwise
violate the rules.

Decriminalization and Crime

Califano cites Dutch crime rates as further proof that decriminalization
is destructive policy. He asserts that, contrary to popular belief, cannabis
decriminalization does not substantially reduce crime: "Any short-term
reduction in arrests after a repeal of criminal drug laws would quickly
evaporate as drug use increased and the criminal conduct  assault,
murder, rape, child molestation, violence, vandalism  that drug
use spawns exploded." The facts do not support such blanket assertions.[10]
In the U.S., 11 states effectively decriminalized marijuana use in the
1970s. Careful analyses of the data from those states show no support
for Califano's predictions. There was no difference between rates of drug
use, addiction, or crime in these 11 states and those in neighboring states
that did not decriminalize.[11]
In The Netherlands, large-scale trafficking in cannabis and all other
drugs remains criminalized, so the Dutch face the same sorts of crime
and violence associated with illicit drug markets that other societies
face. The Netherlands has seen increased crime in recent years 
but no more, and often less, than other industrialized democracies in
Europe which have strict drug laws. Conversely, the U.S. has the harshest
drug laws of any industrialized country in the Western world, and yet
suffers violent crime rates many times higher than those in The Netherlands.[12]
Califano's argument, therefore, also fails the test of common sense.

Califano claims that "Ms. Bonino's argument that adoption of the
Dutch policies by the EU would reduce crime is contradicted by the Netherlands'
own experience." To support this point he writes "The Justice
Ministry acknowledges a steady increase in drug-related crime during the
past decade."[13]
He then cites an alleged increase in "gun-related deaths" in
The Netherlands, "from 73 in 1991 to 100 in 1992, virtually all of
them drug-related." Assume for the sake of argument that not one
of these additional gun deaths had anything to do with alcohol or accidents
or money or mental disorder or jealousy or any of the usual causes. And
let us leave aside the inconvenient fact that even 100 gun-related deaths
 in all of The Netherlands  is less than the number that occur
every year in almost any major American city. Finally, let us also leave
aside the unsupportable notion that the effects of cannabis 
the only drug the Dutch have decriminalized  "causes"
users to kill people with guns.[14]
Taking Califano's argument at face value, a basic question of plausibility
arises: If decriminalization of cannabis is somehow the cause of increases
in gun-related deaths, why would this increase only show up in 1992
when decriminalization began fifteen years earlier? If decriminalization
of cannabis had anything to do with gun violence, this would have been
clear well before 1992.

Immediately following his sentence on increases in gun-related deaths,
Califano writes that "By 1994 Amsterdam had twice as many police
officers relative to its population as the average American city."
Even if we assume this figure is accurate, Califano's inference is a non
sequitir. He seems to believe that having more police could only be caused
by "drug-related" crime, but the Dutch have less such crime
than the U.S. Further, he seems to think that having more police on the
streets, which most Americans clamor for, is an index of danger rather
than of safety. One could more logically argue that a proportionately
higher number of police in Amsterdam illustrates one of the benefits of
decriminalization: Instead of spending law enforcement resources surveilling,
arresting, and processing thousands of cannabis users each year, the Dutch
are able to use their police to make their streets safer, as both their
crime statistics and the millions of American tourists who have visited
there attest.[15]

Curiously, Califano fails to mention that what passes for "drug-related
crime" in the U.S. often stems from the combined push of high unemployment
in America's inner cities and the pull of high profits in illicit drug
markets. Under prohibition, drug sales offer huge profits and thus incomes
that are otherwise unattainable to marginalized people. With such high
stakes and without the possibility of legal regulation, disputes are too
often settled by violence. Califano's case rests on a kind of pharmacological
determinism according to which the mere availability of illicit drugs
 indeed, one illicit drug, cannabis  is the direct cause of
violence and crime. Had he consulted the scientific literature on drugs
and crime, Califano would have discovered, for example, that even most
"crack-related homicides" stem from the exigencies of unregulated
illicit drug markets in deeply impoverished communities, not from the
psycho-pharmacological effects of crack itself.[16]

Califano further claims that decriminalization of cannabis has increased
the number of criminal organizations in The Netherlands. He says that
"From 1988 to 1993, the number of organized criminal groups in the
Netherlands jumped from three to 93." He does not explain what he
means by the vague term "organized criminal group." He cites
no source for the figures, quotes no official, and entertains no other
reason why the number might have increased. The conceptual difficulties
involved in defining "organized crime" are well documented in
the criminology literature and easy to understand.[17]
Every small-time burglary that involves an accomplice and has been planned
may fairly be called "organized." Even the more colloquial definition
of "organized crime," meaning the Mafia or la cosa nostra,
is problematic. Is it one big organization or many smaller ones? Are they
linked formally, informally, or not at all? How do Mafia families and
alliances change over time?[18]
Law enforcement has its hands full trying to identify and map criminal
organizations because, of necessity, they change form and personnel frequently.[19]
Three sub-mafias become one, or one becomes three; drug selling operations
merge or split off. Moreover, police departments periodically change their
operational definitions of "criminal organization" for internal
purposes of record-keeping, report-writing, or fund-seeking.

Had Califano checked with the Dutch Ministry of Justice, he would have
discovered that just such conceptual and definitional problems were the
actual cause of his "jump" in the number of "organized
criminal groups ... from three to 93" between 1988 and 1993. In 1988
the newly created Central Investigation Information bureau (CRI), the
intelligence arm of the Dutch police, produced its first estimate of the
number of organized criminal groups in The Netherlands. They used five
criteria, and to be counted under their 1988 definition a criminal group
had to meet all five criteria. By means of this definition they found
a total of three organized criminal groups in the country. This is apparently
the source for the 1988 figure to which Califano referred. What he did
not refer to, however, was the fact that CRI and Justice Ministry officials
knew at the time that this number was far too low, even for a low-crime
country like the Netherlands. Therefore, the next year the CRI added three
additional criteria, but reduced the number of criteria required for a
criminal organization to two.[20]
Under the new definition, a criminal organization became any group engaging
in criminal activities that fit any two of the eight criteria.
This new definition raised the "official" number of criminal
organizations in the Netherlands to 599, literally overnight. This number,
Dutch officials concluded, was far too high. By 1993, the Dutch police
had further revised their methods for estimating the number of criminal
organizations and came up with the range of 90 to 100, apparently the
second figure to which Califano referred. (He neglected to note that the
precipitous "drop" from 599 to 90-100 occurred under cannabis
decriminalization). As a Parliamentary Commission Report makes clear,
the alleged "jump" in organized crime which Califano takes as
a self-evident consequence of cannabis decriminalization was instead only
an artifact of definitional shifts. Either Califano had not done enough
homework to get the facts or he deliberately distorted them to serve his
argument.

Decriminalization and Drug Consumption Rates

Califano repeatedly claims that decriminalization encourages use of cannabis
and other illicit drugs. Any statement to the contrary, he argues, is
a "myth" that "defies not only experience but human nature."
To support this assertion, he writes that "From 1984 to 1992, Dutch
adolescent marijuana use nearly tripled." As I noted earlier, the
best evidence from Dutch drug use prevalence surveys does not support
this assertion. But Califano also cites the case of Italy, where, he claims,
possession of illicit drugs, "including heroin, was decriminalized
in 1975," and which now "has some 300,000 heroin addicts, and
the highest rate of heroin addiction in Europe." No one knows precisely
how many heroin addicts there are in Italy, but existing prevalence data
do not support the notion that heroin addiction is significantly more
widespread there than in many other comparable European societies where
heroin remains criminalized. More importantly, while it is true that the
Italian government did decriminalize personal possession of small quantities
of illicit drugs in 1975, Califano does not mention that Italy also re-criminalized
personal possession of these drugs in 1985. Only in 1993 did Italian voters
pass a popular referendum that again decriminalized drug possession, and
even this has been undermined by more recent extra-judicial sanctions
that effectively criminalize drug use.[21]
This means that whatever Italy's actual current rate of heroin addiction
may be, it developed largely under criminalization, not decriminalization.

Califano then turns to the U.S. He writes: "In the 1970s, the United
States de facto decriminalized marijuana. A commission appointed by President
Richard Nixon recommended decriminalization, as did President Jimmy Carter.
The result? A soaring increase in the use of marijuana, particularly among
the young." Three parts of this statement are correct. First, President
Nixon did convene the National Commission on Marijuana and Drug Abuse,
comprised of distinguished public figures and scientists, including many
conservative Republicans. Second, after two years of exhaustive study,
the Commission did conclude that the "cure" of prison was worse
than the "disease" of marijuana use, that law enforcement was
not the answer to youthful drug use, and that marijuana use should be
decriminalized. Third, President Carter did advocate decriminalization
of marijuana. In August, 1977, Carter wrote to Congress, "Penalties
against possession of a drug should not be more damaging to an individual
than the use of the drug itself; and where they are, they should be changed.
Nowhere is this more clear than in the laws against possession of marihuana
in private for personal use."[22]

Califano's key assertions on this point, however, are factually false.
The U.S. had not at all "de facto decriminalized marijuana"
in the 1970s. In fact, millions of Americans were arrested and imprisoned
on marijuana charges in that decade, some serving as long as 10 years
in prison for as little as two marijuana cigarettes. While 11 states did
reduce criminal penalties for marijuana possession, 39 others (78%) did
not.[23] At a more basic
level, to attribute the rise in marijuana use in the 1970s to decriminalization
is to stand history on its head. What little decriminalization the U.S.
had was itself largely a result of the rise of youthful marijuana use
that began in the late 1960s.

Califano argues that the notion that "greater availability and legal
acceptability of drugs ... would not increase use" defies "human
nature." Such an shallow concept of "human nature" denies
to humans any self-regulatory powers while granting omnipotence to mere
molecules. Califano implies that harsh criminal laws are the only thing
preventing Mom and Dad and the kids from sticking syringes full of heroin
in their arms. But the epidemiological evidence shows that the vast majority
of people have no interest in illicit drugs, and that even most of those
who experiment with the riskiest of drugs do not go on to regular use,
much less abuse and addiction.[24]
Human drug use and abuse are complex phenomena; mere availability is not
destiny.

Although Califano never once uses the word "poverty," the most
frequent use of the most risky drugs has always been concentrated in the
inner cities, among the most impoverished and vulnerable parts of the
population. Yet even there, where illicit markets are common and hard
drugs widely available, the majority of residents does not use them. Most
people are invested in their lives and simply do not care to let drugs
disrupt them.[25] This
is why drug treatment professionals have long said that the best drug
abuse prevention program ever invented is gainful employment. For Califano
to continue to insist in the face of all the evidence that the roots of
drug problems are pharmacological is to live in a state of sociological
denial.

Public Health Consequences of Decriminalization

Califano also claims that decriminalization has adverse consequences
on public health. To buttress this assertion, he cites what he calls a
Swiss legalization "experiment" in 1987, in which a public park
in Zurich was designated for heroin addicts and where sterile syringes,
condoms, and services were offered. He claims the results were "disastrous"
and that "By 1992, the number of addicts had rocketed to 20,000"
and overdose deaths had risen. There is a kernel of truth here in that
the park he refers to did create problems and was closed. But again Califano
tells only those parts of the story that suit his argument. The Swiss
government never legalized any drug. Rather, they merely attempted to
isolate injection drug users in one locale by instructing police not to
interfere with them in part of one park in one city. They did this because
the number of addicts had already "rocketed." Swiss public
health workers did distribute sterile syringes as well as condoms there,
but that is not "legalization," it is a proven public health
strategy for reducing the spread of AIDS[26]
that is practiced by governments all over Europe and in about 100 U.S.
cities. The main problems with Zurich's "needle park" (including
overdoses) were due in large part to the migration of addicts and dealers
from other parts of the city, from Switzerland as a whole, and even from
other parts of Europe where strict drug laws were in effect.

The problems with the park did not cause the Swiss to abandon
their attempts to find more effective and humane ways of dealing with
heroin addiction. After the park was closed, Zurich and thirteen other
Swiss cities set up experimental out-patient clinics in which sterile
syringes and carefully measured, unadulterated doses are provided to chronic
heroin addicts who had failed in treatment and showed "marked deficiencies
in terms of health and social integration." The Swiss Federal Office
of Public Health funded a rigorous, 2-year follow-up evaluation of these
clinics that was approved by the Swiss Academy of Medical Sciences and
conducted by a team of independent research scientists.

The findings from this study are remarkably positive. Among the more
than 1,000 enrolled addicts, "illicit heroin and cocaine use rapidly
and markedly regressed," while their contact with other addicts and
the drug world "declined massively." Their "criminal offenses
decreased by about 60%" in the first 6 months. The number able to
sustain full-time employment "more than doubled" while the number
unemployed fell from 44% to 20% and one-third of those on welfare were
able to get off. Both their physical and mental health improved and their
debts "were constantly and substantially reduced." There was
not a single fatal overdose among the study population across hundreds
of thousands of injections over two years. Moreover, a cost-benefit analysis
of this experiment showed a net average savings to Swiss taxpayers of
approximately $20 per patient per day.[27]
In fact, the results of this experiment are so promising that Frankfurt,
Germany and other cities have begun to open similar heroin maintenance
clinics.

Califano not only ignores all these positive results, he avoids any mention
of the fact that the new Swiss clinics reduce the needle-sharing practices
that spread AIDS and other diseases. Instead, he turns to Italy, where,
he claims, "70 percent of AIDS cases are attributable to drug use."
He gives no source for this high figure, but he implies, again, that it
is caused by decriminalization. As noted earlier, however, drug use was
re-criminalized in Italy for most of the period since 1985.
Thus whatever the correct number of drug-related AIDS cases, it is difficult
to blame them on decriminalization. To make valid inferences about the
causes of drug-related AIDS cases, one would have to study (among other
epidemiological factors) Italian laws governing syringes and how they
are applied as well as the relative presence or absence of needle exchange
programs. In nearly every country, there is an inverse relationship between
the availability of sterile injection equipment and the rates of HIV/AIDS
among injection drug users.

Children and Drug Use

Califano sounds alarms when he claims that decriminalizing adult drug
use would encourage children to use drugs. This is a phoney issue. All
parties in the drug policy debates in Europe want to decrease the likelihood
of all drug use among children. Virtually every drug policy reform, decriminalization,
and even legalization proposal calls for various measures to keep drugs
out of the hands of the young as much as possible. Califano is right to
say that this will not be easy; he correctly notes the difficulties of
keeping alcohol and tobacco out of the hands of teenagers in the U.S.
But decriminalization does not block governments from making even
better efforts to prevent sales of drugs to minors.

On the contrary, under drug prohibition, governments have almost no ability
to regulate supply and distribution of illegal drugs, for that is left
to black market dealers. Indeed, a large survey sponsored by Califano's
own organization in 1996 found that 42% of American teenagers "find
marijuana easier to buy than either beer or cigarettes."28
In fact, the more punitive drug prohibition is, the more drug use is pushed
underground where it is harder to deal with. The de facto decriminalization
of cannabis in The Netherlands gave federal and local police as well as
regulatory and tax agencies enhanced powers over cannabis sales.
They can, for example, close down coffeeshops immediately if they sell
cannabis products to those under legal age or even if they advertise their
wares.

The fundamental fallacy at the heart of this and most of Califano's other
arguments is the notion that harsh criminal laws have kept either illegal
or legal drugs out of the hands of teenagers who want them. All available
historical evidence suggests that no drug policy is capable of this. But
as noted earlier, fewer young people in Amsterdam have tried cannabis
than in the U.S., with all its harsh laws and long prison sentences. After
two decades of decriminalization of cannabis, there is simply no evidence
of the "savage impact" on Dutch youth that Califano so confidently
predicts.

Drug problems are too serious to be left to the simplistic soundbites
of demogogues. The idea that drug problems are the same everywhere, that
all people and cultures are uniformly vulnerable, and that American-style
punitive prohibition is the right answer for all of Europe is palpable
nonsense. The existing variation in drug policy among EU countries constitutes
a series of natural experiments that should be carefully studied. The
results could tell us a great deal about what is likely to work under
what conditions. At the very least, the evidence to date suggests the
need for a full democratic discussion of the Dutch model and all other
drug policy options  not an attempt to choke off debate by means
of manipulated, misleading, and incomplete information.

Notes

The author gratefully acknowledges the following
people for their assistance in the preparation of this article: Professor
Peter D.A. Cohen and Mr. Arjan Sas of the Centre for European Drug
Research of the University of Amsterdam; Freek Polak, MD, a psychiatrist
in the drug treatment branch of Health Department of the City of Amsterdam;
Dr. Ed Leuw of the Dutch Ministry of Justice in The Hague; Professor
Harry G. Levine, Queens College, City University of New York; Julie
Cooper; Leigh Hallingby; and Andrea Mitchell. The views presented
are those of the author alone.

The fact that Califano served as the top-level
cabinet officer for health and education in the Carter administration
may strike some readers as ironic. Following the recommendations of
the National Commission on Marijuana and Drug Abuse convened by President
Nixon, one of President Carter's first steps, two months into his
term, was to send his top health advisor along with officials from
the federal Drug Enforcement Administration, the State Department,
the National Institute on Drug Abuse, the National Institute of Mental
Health (two agencies within the department headed by Mr. Califano),
the Justice Department, and the U.S. Customs Bureau to testify to
Congress in support of marijuana decriminalization. See Decriminalization
of Marijuana, hearings before the Select Committee on Narcotics
Abuse and Control, March 14-16, 1977, House of Representatives, 95th
Congress, 1st Session (Washington, DC: U.S. Government Printing Office,
1977).

Both surveys were conducted on the age group
10-18 and are cited along with 8 others in a publication funded by
the Dutch National Institute on Alcohol and Drugs: W. M. de Zwart
and C. Mensink, Jaarboek verslaving, 1995 [Yearbook on Addiction,
1995](Houten/Eiegem, NL: Bohn Stafleu Van Loghum, 1996), p. 59.

For a thorough account of the history of the
revised Dutch Opium Act of 1976 which created de facto decriminalization
of cannabis, see Sebastian Scheerer, "The New Dutch and German
Drug Laws: Social and Political Conditions for Criminalization and
Decriminalization," Law and Society Review 12:585-606
(1978). For details on how the policy has operated, see Govert van
de Wijngaart, "The Social History of Drug Use in The Netherlands:
Policy Outcomes and Implications," Journal of Drug Issues
18: 481-495 (1988); Frits Ruter, "Drugs and the Criminal Law
in the Netherlands," pp. 147-165 in J.U. van Dijk et al., eds.,
Criminal Law in Action: An Overview of Current Issues in Western
Societies (Arnhem, NL: Gouda Quint, 1988); E. L. Engelsman, "Dutch
Policy on the Management of Drug-Related Problems," British
Journal of Addiction 84:211-218 (1989); and Ed Leuw, "Drugs
and Drug Policy in the Netherlands," in M. Tonry, ed., Crime
and Justice 14:229-276 (University of Chicago Press, 1991).

European Monitoring Centre for Drugs and Drug
Addiction, Annual Report on the State of the Drugs Problem in the
European Union (Lisbon, Portugal, 1996); for an accessible overview
of the nature and effects of the Dutch policy, also see The Dutch
Drug Policy: Continuity and Change (The Hague: Ministry of Health,
1996).

While the Christian Democratic Party is not
presently in the governing majority coalition, it has been part of
most such coalition governments in recent decades, including those
that enacted and defended the current drug policy.

Space limitations prevent a full critique of
the claim that marijuana use "spawns" murder, rape, child
molestation, violence, etc.

U.S. homicide rates, for example, traditionally
have been about fifteen times higher than those of The Netherlands.
See, e.g., Rosemary Gartner, "The Victims of Homicide: A Temporal
and Cross-National Comparison," American Sociological Review
55:92-106 (1990). See also Elliott Currie, Confronting Crime: An
American Challenge (New York: Pantheon, 1985); Marvin E. Wolfgang,
"Homicide in Other Industrialized Countries," Bulletin
of the New York Academy of Medicine 62:400-412 (1986); and World
Health Organization, World Health Statistics Annual: Vital Statistics
and Causes of Death (Geneva: WHO, 1996).

Mr. Califano neither names nor quotes a Justice
Ministry official or document. To check on this, we showed Califano's
article to a Dutch Ministry of Justice scientist who said, "This
man is insane."

This claim is paradoxical because one of the
principal "harms" of marijuana that Mr. Califano elsewhere
worries about is the so-called "amotivational syndrome,"
i.e., marijuana allegedly makes users lethargic, stupefied, unmotivated,
etc. In terms of psycho-pharmacological effects, it is hard to have
it both ways  murderous violence and lethargy, etc.

Califano also omitted from his essay the fact
that by far the strongest association between drug use and crime is
for a legal drug  alcohol. In the U.S., alcohol is present in
half or more of the murders, rapes, and assaults that he attributes
to illicit drugs. But even this robust statistical association bears
scrutiny, for correlation is not the same as causation. As Robin Room
has pointed out, the nature of the alcohol-crime nexus depends on
how one asks the question. If one asks, How many criminal events involve
alcohol?, the answer is "lots." But if one asks, How many
drinking events involve crime?, the answer is "precious few."
Other countries have higher per capita consumption of alcohol but
nowhere near the rates of murder, rape, and assault found in the U.S.
This shows that the relationship between alcohol use and crime is
contingent on cultural and social structural factors. Thus not even
alcohol can be understood as a direct cause of crime. See Craig MacAndrew
and Robert Edgerton, Drunken Comportment (Chicago: Aldine,
1969); Robin Room and Gary Collins, Eds., Alcohol and Disinhibition,
NIAAA Research Monograph 12 (Rockville, MD: National Institute
on Alcohol Abuse and Addiction, 1983); Harry G. Levine, "The
Alcohol Problem in America," British Journal of Addiction
79:109-119 (1984); Craig Reinarman and Barbara C. Leigh, "Culture,
Cognition, and Disinhibition: Sexuality and Alcohol in the Age of
AIDS," Contemporary Drug Problems 14:435-460 (1987).

One such study was funded by the U.S. Department
of Justice (used as source by Mr. Califano), which chose to print
and circulate it as an exemplary piece of research: Paul J. Goldstein
et al., "Crack and Homicide in New York City, 1988," Contemporary
Drug Problems 16:651-687 (1989).

The Dutch Central Investigation Information
bureau (CRI) was formed in 1987 and produced its first estimate of
the number of "organized criminal groups" in 1988. That
estimate used 5 criteria: a hierarchical structure; sanctions for
non-compliance with its rules; a system for laundering money; evidence
of instigation of corruption; and repeated criminal activity. Using
this definition, CRI found a total of 3 criminal organizations in
The Netherlands, which they considered far too few. So in 1989, the
CRI adjusted its methods of categorization to include 8 criteria,
but defined "organized criminal group" as any organization
that satisfied any two of these 8. Using this looser definition,
such groups numbered 599, which officials felt was far too many if
the term "organized criminal group" was to have any meaning.
Further refinement of their methods resulted in an estimate of between
90 and 100 such groups by 1993. This process of shifting and refining
measures is fully explained in the final report of the Dutch Parliamentary
Commission on Methods of Police Investigation, Inzake Opsporing:
Enquetecommissie opsporingsmethoden [About Criminal Investigation:
Final Report of the Parliamentary Commission on Methods of Police
Investigation] (den Haag, NL: Sdu Uitgevers, 1996), pp. 26-37.
Like the criminology literature, the Parliamentary Commission report
notes the conceptual difficulties involved: "organized criminality
is a diffuse and constantly changing network of individuals and groups."
(p. 35)

"President's Message to Congress on Drug
Abuse," pp. 66-67 in Strategy Council on Drug Abuse, Federal
Strategy for Drug Abuse and Drug Traffic Prevention, 1977 (Washington,
DC: U.S. Government Printing Office, 1967); see also "Drug Law
Revision" [text of President Carter's message to Congress], Congressional
Quarterly Almanac 32:41E et passim (1977); and, for more details,
see Eva Bertram et al., Drug War Politics (Berkeley and London:
University of California Press, 1996).

Further, if punitive prohibition laws are what
keep young people away from marijuana, why have the last four annual
drug use prevalence surveys of 8th, 10th, and
12th graders in the U.S. shown marijuana use rising again
 after some of those 11 states had again toughened their
drug laws, and among precisely the generation of young Americans exposed
to more antidrug education and advertising than any other in history?
See Johnston, Lloyd D., O'Malley, Patrick M., and Bachman, Jerald
G., National Survey Results on Drug Use from the Monitoring the
Future Study, 1975-1995, Volume 1: Secondary School Students (Rockville,
MD: National Institute on Drug Abuse, 1996).

See, e.g., the high rates of discontinuation
(i.e., the drop-off between lifetime prevalence and last-year and
last-month prevalence) in National Household Survey on Drug Abuse:
Main Findings, 1994 (Rockville, MD: Substance Abuse and Mental
Health Services Administration, Office of Applied Studies, 1995),
and the drug use prevalence surveys of the general population of Amsterdam
(Sandwijk et al., 1990, 1994), op cit., note 5.

On the notion that "stake in conventional
life" mitigates against drug abuse and addiction, specifically
in the case of cocaine, see, e.g., D. Waldorf, C. Reinarman, and S.
Murphy, Cocaine Changes: The Experience of Using and Quitting
(Philadelphia, PA: Temple University Press, 1991); with regard to
crack and more generally, see C. Reinarman and H.G. Levine, eds.,
Crack in America: Demon Drugs and Social Justice (Berkeley,
CA: University of California Press, 1997).

On the efficacy of needle exchange in reducing
the spread of AIDS, see, e.g., D. Des Jarlais and S. Friedman, "AIDS
and Legal Access to Sterile Injection Equipment," Annals of
the American Academy of Political and Social Science 521:42-65
(1992); U.S. Centers for Disease Control and Prevention, The Public
Health Impact of Needle Exchange Programs in the U.S. and Abroad
(Rockville, MD: National AIDS Clearinghouse, Centers for Disease Control
and Prevention, 1993); and J. K. Watters et al., "Syringe and
Needle Exchange as HIV/AIDS Prevention for Injection Drug Users,"
Journal of the American Medical Association 271:115-120 (1994).
It is also worth mentioning, as Mr. Califano knows, that every government
and scientific commission that has examined the medical and scientific
literature on the efficacy of needle exchange, including one set up
by President Reagan, has concluded that needle exchange does help
prevent HIV/AIDS  without increasing drug use.

The source for all figures and quotations cited
is Ambros Uchtenhagen, Felix Gutzwiller, and Anja Dobler-Mikola (eds.),
Programme for a Medical Prescription of Narcotics: Final Report
of the Research Representatives (Berne, Switzerland: Swiss Federal
Office of Public Health and Addiction Research Institute, Zurich,
1997). For further background research, see M. Rihs-Middel, "Medical
Prescription of Narcotics in Switzerland," European Journal
on Criminal Policy and Research 2:69-88 (1994); Swiss Federal
Office of Public Health, Status Report on the Medical Prescription
of Narcotics (Liebefeld, Switz.: Swiss Federal Office of Public
Health, 1995); Killias, M. and Uchtenhagen, A., "Does Medical
Heroin Prescription Reduce Delinquency Among Drug Addicts?: On the
Evaluation of the Swiss Heroin Prescription Project and its Methodology,"
Studies on Crime and Prevention 5 (1996); H. Klingeman, "Drugs
Treatment in Switzerland: Harm Reduction, Decentralization, and Community
Response," Addiction 91:723-736 (1996); T. Z. Perneger,
F. Giner, M. del Rio, and A. Mino, "Heroin Maintenance Under
Medical Supervision: An Experimental Program for Heroin Users Who
Fail in Conventional Drug Abuse Treatments," Institute of Social
and Preventative Medicine, University of Geneva, Switzerland, 1997.

National Survey of American Attitudes on
Substance Abuse II: Teens and Their Parents (New York: Center
on Addiction and Substance Abuse, 1996), p. 2.